Efforts to rehabilitate health systems after periods of prolonged conflict have often been characterized by poor coordination of external actors - multilateral agencies, donors and non-governmental organizations (NGOs). This paper describes the process and analyses the roles of the different stakeholders in the establishment of a government-led district health system in East Timor, between 1999 and 2002, after decades of chronic conflict and Indonesian occupation.

Future East Timorese policy-makers and health professionals began to mobilize in May 1999, in preparation for independence. During the emergency phase, from September 1999, when violence erupted, to March 2000, NGOs played a major role in the provision of relief to the population, coordinated by United Nations agencies. An Interim Health Authority, led by local Timorese, was established in March and the major donors began to shift funding from NGOs to the newly established Ministry of Health. A rapid phasing-out of NGOs, accompanied by a sequence of steps to build the capacity of Timorese to manage the new district health system, was implemented. Early evidence shows that health service utilization continued to grow during and after implementation.

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This case study highlights that despite the challenges in integrating gender equity concerns into the health system in Timor-Leste, overall, the reform of the health system since conflict ended has benefited women’s health. In some areas, Timor-Leste has achieved some key targets, for example the proportion of births attended by a skilled health worker and contraceptive use.

The Timor Leste secession conflict lasted for 25 years. Its last wave of violence in 1999, following the withdrawal of Indonesian troops, generated massive displacement and destruction with widespread consequences for the economic and social development of the country.

This paper analyzes the impact of the wave of violence that occurred in Timor Leste in 1999 on education outcomes. We examine the short-term impact of the violence on school attendance in 2001 and its longer-term impact on primary school completion of the same cohorts of children observed again in 2007.

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